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Current Anesthesiology Reports
Published in: Current Anesthesiology Reports 3/2019

01-09-2019 | Anemia | Cardiovascular Anesthesia (J Fassl, Section Editor)

Patient Blood Management in Cardiac Surgery

Authors: Daniel Bolliger, Andreas Buser, Joachim M. Erb

Published in: Current Anesthesiology Reports | Issue 3/2019

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Abstract

Purpose of the Review

Recently, several large randomized studies and recommendations regarding patient blood management (PBM) in cardiac surgery were published. This review summarizes the current evidence relating to modern strategies in PBM from the perspective of the cardiovascular anesthesiologist.

Recent Findings

Preoperative anemia should be early detected and adequately managed. In patients with intake of anticoagulants or platelet inhibitors, timely and specific stopping should be respected. Specific modification of cardiopulmonary bypass (CPB) systems aiming to reduce hemodilution and conserve patients’ blood reserve have been described. In combination with the use of cell-saving systems, such modifications might reduce the need for blood transfusion. Applying the restrictive transfusion thresholds for red blood cells (hemoglobin threshold close to 70 g/L) is not inferior to a liberal strategy (threshold close to 100 g/L) regarding 30-day mortality, and important outcomes including myocardial infarction, stroke, renal failure, infections, or arrhythmia. Finally, timely diagnosis and adequate treatment of hemostatic abnormalities by specific procoagulant interventions should be considered.

Summary

To optimize the risk-benefit ratio of allogeneic blood transfusion and to reduce associated costs, the implementation of PBM programs compromising a multidisciplinary and multifactorial approach including interventions before, during, and after surgery is suggested.
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Metadata
Title
Patient Blood Management in Cardiac Surgery
Authors
Daniel Bolliger
Andreas Buser
Joachim M. Erb
Publication date
01-09-2019
Publisher
Springer US
Published in
Current Anesthesiology Reports / Issue 3/2019
Electronic ISSN: 2167-6275
DOI
https://doi.org/10.1007/s40140-019-00343-y

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